Post-natal Depression CBT group: Making the Most of Motherhood (MMOM)

 

There are a high percentage of women that do not seek support for this condition which may be due to stigma, fear of consequences of doing so, dysfunctional beliefs and perceptions about motherhood and ability to cope. PND exerts a negative impact upon couple relationship; development of infants; development of psycho-social problems resulting in poor social skills, reluctance to seek support, excessive self-monitoring of negative events, insufficient self-reward and excessive self-punishment. Therefore this treatment aims to improve access to mental health services and the diagnosis and support of woman experiencing PND.

Group Duration:  

 

2 hours, 10 weeks, weekly appointments with 3 optional additional x 1 hour partner sessions in adjunct to group sessions. 

 

Referral criteria:  

 

Ante-natal depression (onset during pregnancy); reactive depression to birth trauma; PND/any depression detected within the first 12 months after delivery / within the first year of the youngest child’s life.  

 

Exclusion criteria: 

 

Bipolar disorder, psychosis or PTSD as a result of a traumatic birth; development of depressive symptoms after one year of birth and Postnatal (puerperal) psychosis. 

 

Stats/facts: 

 

Perinatal mental illnesses (PMI) are a range of conditions that affect at least 10% of new mothers, during pregnancy or within the first year after childbirth. Post-natal depression (PND) is most prevalent effecting 10-15% of every 100 women who give birth; Obsessive Compulsive Disorder (OCD) onset or worsening of symptoms associated with pregnancy and childbirth may be due to a hormonal change and psychological stress of pregnancy and infant care and effect 3% of new mothers; postpartum psychosis is severe mental illness affecting 2 in 1000 new mothers; PTSD is estimated at effecting 3% of mothers particularly women who have experienced childhood abuse and sexual abuse, who may experience complex feelings around becoming a parent and physical care experienced in pregnancy; paternal depression 25-50% of new fathers with depressed partners are depressed, and is shown to affect couple relationship and the developing infant; some women with a history of PMI have 50% chance of recurrence in subsequent pregnancy.   

 

Intervention:  

 

Psycho-education group (PEG) providing information on PND, strategies  for coping with difficult child-care situations and eliciting social support; use of cognitive and behavioural techniques to tackle women’s unhelpful beliefs about motherhood and provide strategies for dealing with distress/anxiety; teaching relaxation and mindfulness; problem solving, simple behaviour activation. 

 

Objectives: 

 

This therapeutic group is unique in its attempt to address maternal mood & the transition to motherhood with an aim of providing social, community & peer support for both mothers & fathers (via partner assisted sessions in adjunct to group therapy sessions for mothers) along with information & education regarding PND & providing psychological therapy using CBT & Mindfulness as an integrative modality. 

 

This therapeutic group attempts to reduce the sense of isolation, promote social inclusion, and improve access to psychological therapies such as CBT, Mindfulness, ACT, couples therapy & other interventions.  

 

 

Content:  

 

Session 1 - Behavioural Interventions 

Pregnancy, birth & now  

What is PND? 

Strategies for improving mood 

 

Session 2 - Pleasant activities 

Psycho-education - the bio psychosocial model to PND  

Psycho-education: increasing pleasant activities  

 

Session 3 - Relaxation on the run 

Psycho- education: relaxation training 

Mindful parenting   

Various relaxation techniques 

 

Session 4 - Assertiveness and self esteem 

Psycho- education assertive skills 

Assertive/ Passive / Aggressive styles  

Assertive training  

 

Session 5 - Unrealistic expectations of parenting 

Psycho-education family of origin 

Psycho-education challenging unhelpful thoughts and unrealistic expectations of parenting  

 

Session 6 - My internal dialogue 

Psycho-education: self-instruction techniques   

 

Session 7 - Developing a more helpful thinking style 

Psycho-education mind games and negative thoughts  

Psycho-education ways to reduce native thoughts and increase positive thoughts  

 

Session 8 - Challenging my internal critic Challenge thoughts and feelings Psycho-education - disputing and shifting cognitive distortions  

 

Session 9 - putting it all together 

Psych-education maintaining your gains, social support & Individual exercise my goals 

 

Session 10 - Consolidating what I have learnt 

Changes in mood 

Medium to long term goals 

Social support 

High risk situations 

Life style modification 

 

Couple session: 1 partners and PND 

Introduction to PND and contributing factors  

Explore fathers feelings and how life has changed since the baby  

Survival tips for partners  

Fathers expectations and experiences of parenthood  

 

Partner session 2 - The couple relationship 

Feedback from last session 

Lovers to parents; Time for us; Time for me 

Communication skills – sharing positive and negative thoughts and feelings 

 

Session 3 partners session - doing it ourselves 

Symptoms; Support; Relationship; Communication 

Problem solving, negotiation

Learning outcome for clients: 

 

• Promote Problem Solving 

• Increase positive activities for pleasure and satisfaction (for self, partner & baby) 

• Increase self-nurturing activities  

• Learn relaxation skills 

• Enhance assertiveness and communication skills  

• Build support networks  

• Manage anger 

• Overcome Anxiety & avoidance 

• Increase positive thoughts  

• Decrease negative thoughts  

• Challenge Unhelpful thinking patterns 

 

Noticing & changing unhelpful thinking: 

 

Unhelpful thinking styles / errors 

 

1. Label thought as just one of those unhelpful thoughts  

 

2. Stop observe think & reflect - don't get caught up in thinking process, just notice content 3. Move on & don't let thoughts stop you from what you were doing 

 

4. Respond  - increase a compassionate and non-judgmental response 

 

5. Questions your thoughts - examples of questions 

 

Overcoming sleep Problems 

 

Conclusion/Ending: 

 

If you or someone you know are experiencing PND, then access support via a health care professional or seek a support group or therapy to learn skills to manage & reduce symptoms & improve your maternal mood to make the most of motherhood. 

 

There is an increase in paternal depression affecting 25-50 of new fathers with depressed partners. Nice guidelines recommend than women are seen within one month of assessment for PND as the effects can be devastating for mother & baby. 

 

It is important to access treatment or support early as most women respond well to self-help, support groups, CBT & other therapies, mindfulness, ACT.  If you are interested in this course or another therapeutic approach then please do not hesitate to contact me to seek individual therapy or access this group therapy.